This proposed project will be a three-state study of the impacts of special care units (SCUs) and special care practices within nursing homes for persons with Alzheimer's Disease (AD). The primary goal of the study is to determine consequences of the various components of special care units and/or programs for nursing home residents with AD, their family members, and nursing home staff members. The four-year, longitudinal, three-stage research design will move from initial exploratory and descriptive processes to derivation of models, to testing of models that include reciprocal effects between outcome variables. The intent is to (1) identify, describe, and measure the key elements of specialized programs and units (the independent variables); (2) assess the impact of each element on the outcome variables (resident, family, and staff outcomes), and (3) identify the process by which different elements impact resident outcomes over time. Data will be collected from approximately 60 nursing homes in Michigan, Washington, and North Carolina. In each state, the sample will consist of all nursing homes with an SCU and an equal number of nursing homes without an SCU that will be selected to be comparable in location, size, and proprietorship. Data regarding nursing home policies and practices will be collected through interviews with key administrators and staff. Staff members of each nursing home will be paid to collect data regarding approximately 15 residents with AD from records and observations. Additionally, questionnaires will be distributed to family members and staff members. The initial year of the study will be devoted to measurement development and instrument construction. Three waves of data will be collected at six month intervals, beginning in the second year, and model construction and testing will take place in the fourth and final year.